ICD-11

The International Classification of Diseases (ICD) is a health statistics coding tool that aims to describe an entity that is challenging to quantify and even more problematic to standardise—the human condition. The history of ICD dates back to 16th century England where deaths from distinctly medieval causes (scurvy, leprosy, and plague) were announced by the London Bills of Mortality on a weekly basis. It was only at the end of 19th century that statistical data gathering of diseases and deaths began, triggered by the introduction of Bertillon Classification of Causes of Death and the advocacy of Florence Nightingale. By the 1940s, WHO had assumed responsibility for the ICD. Since then it has undergone revisions to reflect advances in health and medical science. On May 25th, 2019, the 11th Revision of ICD (ICD-11) was presented at the 72nd World Health Assembly, having been launched in June, 2018. Over a decade in the making, ICD-11 has now been updated for the 21st century. ICD-11 is a substantial improvement on ICD-10. 55 000 unique codes for injuries, diseases, and causes of death are included, compared with 14 400 for ICD-10. A wide consultation led to 10 000 proposals for change. New to ICD-11, for example, is a chapter on sexual health, which brings together several conditions that were previously classified differently. Gender incongruence is included in this new chapter, reflecting an understanding that it is not a mental health condition. Reclassification should help to reduce the stigma attached to gender-defined states. Another new chapter focuses on traditional medicine, commonly used across many countries, including China, Japan, and the Republic of Korea. It is right that traditional medicine services are brought within the perimeter of mainstream medicine, although WHO's Director-General has made clear this chapter “does not refer to—nor endorse” any specific form of traditional medicine treatment. In a landmark decision, stroke has now formally been listed as a neurological disorder and not a disorder of the circulatory system. This important change is long overdue and will bring stroke out of the shadows of heart disease. The new classification of HIV recognises advances in HIV therapy, which should now be seen as a chronic condition. Allergy is coded under diseases of the immune system. Attention deficit hyperactivity disorder's updated description states that the symptoms no longer have to occur within fixed age range to lead to diagnosis. The updates also enable better reporting of antimicrobial resistance, with codes that are more in line with the Global Antimicrobial Resistance Surveillance System. In this iteration of the ICD, special attention has been dedicated mental health. Simpler diagnostic descriptions will make mental health diagnoses more accessible to health-care professionals globally. For instance, the ICD-11 list of post-traumatic stress disorder criteria have been reduced to facilitate easier diagnosis and improve access to treatment. Addictive conditions, such as gaming and hoarding disorders, have been added. Compulsive sexual behaviour was included as an impulse control disorder, following a decade-long debate about whether this condition should be listed as a mental or behavioural condition. The latest revision also provides a more detailed definition of burn-out than ICD-10, classifying it as an occupational phenomenon that stems from chronic work-related stress. Although ICD-11 refrains from coding burn-out as a medical condition, it does characterise it as a syndrome, defined by three dimensions—exhaustion, reduced professional efficacy, and increased mental distance from one' s job or feelings of cynicism or negativism about one's job ICD-11 has an improved ability to code for the quality and safety of health care and highlights the role of external factors that directly and indirectly contribute to people's health, such as insufficient social welfare support. Overall, this revision is a huge step forward for health worldwide. The fully electronic nature of ICD-11 will assist implementation, reduce errors in diagnosis, and make it more adaptable for local country contexts. The common language of health and medicine is now more fit-for purpose than it has ever been. ICD-11: a brave attempt at classifying a new worldThe 11th version of the International Classification of Diseases (ICD) launched on June 18 is the latest attempt at systematically describing and categorising all human mortality and morbidity. Designed for the global digital age, it is an onscreen, multipurpose, multilingual database interconnecting with other operating systems—including electronic hospital records. It is a quantum leap forward from the ICD-10, which, although revised several times over the past two decades, was originally published in 1992, when internet use was minimal, smartphones were unheard of, and patient records were paper based. Full-Text PDF